Monday, March 31, 2008


Washington -- The jumble of terms in health information technology soon could be simplified. The National Alliance for Health Information Technology announced March 24 that it finished proposed definitions for five key HIT terms and will seek public comment on them until April 9.

The ONC chose the terms because they are the most often confused. Lawmakers have proposed bills that use the terms in different ways, said Karen M. Bell, MD, director of the ONC's Office of HIT Adoption.


After the definitions are finalized, the ONC will officially adopt them and use them in its contract language, said alliance Vice President and Chief Marketing Officer Jane Horowitz, who leads the project. Organizations and companies should follow and operationalize the definitions throughout health care, she said

One of the most significant developments would be distinguishing EMRs from EHRs. The two are frequently used interchangeably. The alliance proposed identifying an EMR as medical information on an individual patient from a single organization, including affiliated settings. EHRs would be data on a patient aggregated from multiple organizations.

The National Alliance for Health Information Technology has proposed definitions for several common health IT terms:

Electronic medical record: A computer-accessible resource of medical and administrative information available on an individual collected from and accessible by health care professionals involved in the patient's care within a single care setting.

Electronic health record: A computer-accessible, interoperable resource of clinical and administrative information pertinent to the health of an individual. The information, drawn from multiple clinical and administrative resources, is used by a broad spectrum of clinical personnel. This enables them to coordinate the patient's care and promote wellness.

Personal health record: A computer-accessible, interoperable resource of pertinent health information on an individual. Unlike the EHR, however, the PHR is managed by the patient, and the patient determines who has the right to access and use it. The information originates from multiple sources and is used by individuals and their authorized clinical and wellness professionals to help guide and make health decisions.


The terms health information exchange and regional health information organization have overlapped, the alliance said. It based its definitions on their root meanings. HIE reflects the technological aspects of sharing data, while RHIO reflects the drive for better health care quality and efficiency within a region.

So the alliance defined HIE as the electronic movement of health-related data across nonaffiliated organizations in a way that protects privacy and security.

It defined a RHIO as a multi-stakeholder governing entity responsible for electronic information exchange within a geographic area. A RHIO must involve data sharing between separate entities in a defined area whose collaboration crosses organizational boundaries. It also must be focused on the greater good of a defined population area, instead of specific disease communities, such as a network exchanging information only on diabetics.

Saturday, March 22, 2008

The Chart at the Foot of the Bed is Gone

Sorry for being absent the past several weeks. Recently I had the unexpected opportunity to catch up on technology at the bedside (in the bed) at my local community hospital which I had been on the staff 16 years ago.  I had been away in another community and only recently had returned to the area but practice in a more rural community in the same town.  Some things change, and others never change. Chest pain is chest pain and shortness of breath are the same complaints.  My arm band now had a bar code on it. The nurses all used wireless laptops for charting and reading orders.

The doctors were all still at the nursing stations either dictating or writing their chart notes. The doctors seem to be the last link in the chain of IT.  I definitely had the feeling IT was "leaking in".

At my post operative visit in the cardiologist's office he was able to retrieve summaries, op reports and demographics via a portal, although he had not yet implemented EMR in his office.

I am now the beneficiary of a cardiac stent, placed into a ten  year old coronary vein graft which had only 1% flow through it. Although ten years had passed without incident the old leg scar is still quite evident, more so than the long chest scar.

At the end of the rather prolonged angioplasty I was given a CD with a DICOM viewer and video for my own personal health record.  Pictures are worth a thousand words and in the future if I have to have any other procedures this will be instantly available.

This was a far cry from the CABG (4 vessels) that was performed on me ten years ago.  I was given a hand sketch of that procedure, which was lost many years ago and unavailable on short notice.

(not many patients are given advanced notice of acute coronary syndrome).

Just six months ago I had returned to near full time ophthalmology practice......the volume was up from 40 patients a day to over 50 patients a day. The practice had no EMR. Those are the numbers in productivity that are needed in some setting with capitation and/or heavy managed care intrustion, unless one adds cosmetic and/or refractive surgery to the mix.  Most doctors want one thing from an EMR....improved efficiency and reduced cost, and not over a pay back of more than one year. ROIs must be short because the only predictability of reimbursement is that it will decrease and bureaucracy will increase.  Common sense must intrude into the mix of the business of medicine.

Too many think tanks and doctor wannabees are draining dollars from patient care. Much of medicare's "fraud and abuse" mechanism revolve around inaccurate coding (obsolete ones), and complex schemes that require a graduate level education to understand.

My outlook is rather dismal....I used to be one of those optimistic "the glass is half full", now it is the other way around..."it is half empty".  Yes, those who can negotiate the system get excellent care.....there will be more care for fewer patients.

The economic engine for a typical practice bears no relationship to how doctors are trained, nor how they want to practice medicine.....Non practitioners have no idea of the stresses involved and why doctors burn out from a profession that initially was very gratifying and rewarding. 

I remain hopeful that IT will assist us all in patient care, and not become another misguided burden in caring for patients.

And, oh, by the way the bar coder broke and the nurse was delayed by over an hour trying to get medication for me. Imagine what it will be like when the server "crashes" (not if)

Happy Passover and Easter to all